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 20 April 2018

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News

Immunostimulating nutrition and complications after upper GI surgery

This month‘s Annals of Surgery examines the impact of immunostimulating nutrition on infectious complications after upper GI surgery.

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Immunomodulating nutrition is supposed to reduce the number of complications and lengthen of hospital stay during the postoperative period in patients after major gastrointestinal surgery.

Dr Stanislaw Klek and colleagues assessed the clinical effect of immunostimulatory enteral and parenteral nutrition in patients undergoing resection for gastrointestinal cancer in a group of well-nourished patients.

There were differences between infectious complications using parenteral nutrition vs formulas
Annals of Surgery

The team evaluated a group of 214 well-nourished patients between 2001 and 2005.

The research team subsequently excluded 9 patients from the study.

The remaining 205 subjects were randomly assigned using a factorial design into 4 study groups.

The team randomized 53 patients to standard enteral nutrition, 52 to immunomodulating enteral nutrition, 49 to standard parenteral nutrition, and 51 to immunomodulating enteral nutrition.

The researchers tested the hypothesis that immunonutrition and enteral nutrition would reduce the incidence of infectious complications after upper gastrointestinal surgery.

The team's secondary objective was to evaluate the effect of nutritional intervention on overall morbidity and mortality rates, and hospital stay.

The researchers found that the overall morbidity rate was 33%, and the incidence of individual complications was comparable between all groups.

Infectious complications occurred in 26 of 102 patients given standard diets and in 22 of 103 patients receiving immunomodulatory formulas.

The team found no significant differences between infectious complications in patients using parenteral nutrition, and parenteral formulas.

Neither immunostimulating formulas nor enteral feeding significantly affected secondary outcome measures, including overall morbidity and mortality rates, and hospital stay.

Dr Klek‘s concluded, "Our study failed to demonstrate any clear advantage of routine postoperative immunonutrition in patients undergoing elective upper gastrointestinal surgery."

"Both enteral and parenteral treatment options showed similar efficacy, tolerance, and effects on protein synthesis."

"Parenteral nutrition composed according to contemporary rules showed similar efficiency to enteral nutrition."

"However, because of its cost-efficiency, enteral therapy should be considered as the treatment of choice in all patients requiring nutritional therapy."

Ann Surg 2008: 248(2): 212-20
30 July 2008

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